The Wicked Politics of Clinical Practicum in Nursing School

by TheCommuter Asst. Admin

21,799 Views | 69 Comments

This article is a channel to discuss some of the nastier aspects regarding the politics that pervade clinical rotations in nursing school. The grades you receive in clinical practicum are purely subjective, so a highly skilled nursing student might still fail this portion of his nursing education if he ends up on a faculty member’s bad side due to personality conflicts.

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    The Wicked Politics of Clinical Practicum in Nursing School

    Nursing school is not always fair. And, in my honest opinion, the most unfair aspect of the nursing school experience is the clinical practicum portion, also known as ‘clinical rotations.’ Here is why.

    The grades that students earn in the classroom-based theoretical nursing courses are, in most cases, usually objective. Even though the professor who teaches the advanced medical/surgical nursing course might hold personal grudges against a couple of students, the multiple choice exams and quizzes help to even the playing field by giving all pupils a fair chance to demonstrate their knowledge base.

    A few exceptions exist, such as the occasional poorly written test question, and the subjectively-graded essay or paper. However, students who are personally disliked by their classroom professor, classmates who are outspoken or opinionated, and those who have been labeled as difficult ‘trouble makers’ by certain faculty members can still pass (and even do well) in the theory portion of their nursing courses through strong performance on objectively graded tests if they study, use all the resources at their disposal, and fully comprehend the material.

    On the other hand, the grades students receive in the clinical practicum portion of their nursing school educations are purely subjective and based almost solely on the opinion of the clinical instructor. This is certainly not a problem if the clinical instructor is fair, balanced, rational, has realistic expectations of pupils, and capable of modulating his or her emotions while evaluating students’ performance. It also helps greatly if the clinical instructor possesses a true fondness for transmitting nuggets of knowledge and wisdom to the next generation of nurses.

    Let’s return to the subjective evaluation of the clinical portion of nursing education. This is not problematic if the instructor is fair and impartial. However, the end result could be a disaster if an outspoken or mouthy student is being taught by a clinical instructor who has old-fashioned values and expects students to obey, conform, comply, respect authority, and avoid painting her in an unfavorable brush in front of others. No matter how intelligent or skilled the student might be, he will almost certainly fail clinical practicum if he rubs his instructor the wrong way.

    Many clinical instructors currently work in inpatient settings such as hospitals where they practice procedural skills regularly; teaching students is a second job for these instructors. However, other clinical instructors exist in academia who have not regularly performed patient care in many years. You may notice some of these instructors performing skills in an outdated manner, or quite possibly, they might do something incorrectly.

    The outspoken student who announces in front of other students and nurses in the clinical setting that “Mrs. Smith gave a bolus tube feeding while the patient was laying flat in bed” will become a target, even if he is right and the instructor was wrong. This is the same instructor who will be checking students off on skills. This is the same instructor who evaluates students’ performance and determines who passes or fails the clinical practicum.

    If the instructor is the old-fashioned type who does not like it when students correct her in public, do you think she’s going to penalize the mouthy student? If she disapproves of students who question authority, do you think she might give the student who openly questions her a hard time? Keep in mind that if she refuses to check you off on a skill, it is her word against yours. If she insists you failed your most recent clinical rotation due to substandard performance, be cognizant that the director of the nursing program might side with her.

    I’ve revealed the nastier side of the politics that permeate clinical rotations in nursing school. My advice is to pick your battles wisely and tread very carefully. Think before you speak, especially when addressing instructors who make grading decisions that impact your future. The grades you receive in clinical practicum are purely subjective, so do not end up on a faculty member’s bad side due to your strong personality and outspokenness. Be aware that no matter how bright you are, the evaluation of one dishonest clinical instructor who dislikes you can set your career back.

    Learn to walk the political tightrope. After all, what you know is often as important as who you know in this day and age. Keep that bull’s eye off your back.
    Last edit by TheCommuter on Mar 5, '13
    mharzi, mlj8955, man-nurse2b, and 19 others like this.
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  3. About TheCommuter

    TheCommuter is a moderator of allnurses.com and has varied workplace experiences upon which to draw for her articles. She was an LPN/LVN for four years prior to becoming a registered nurse.

    TheCommuter joined Feb '05 - from 'Fort Worth, Texas, USA'. Age: 33 TheCommuter has '8' year(s) of experience and specializes in 'acute rehab, long term care, and psych'. Posts: 26,846 Likes: 37,732; Learn more about TheCommuter by visiting their allnursesPage Website


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    69 Comments so far...

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    You make some interesting points and I'm sure there are some "dishonest" clinical instructors out there (although I've never run into any, myself), but I would argue that knowing (or learning) how not to "rub his (sic) instructor the wrong way" is just as useful a skill as anything else one masters in nursing school. Are you suggesting that clinical in nursing school is the only situation one will encounter in one's career in which one will need to adjust to a superior's expectations and values? I've been doing it fordecadesnow, in every job I've ever held. That is just a basic expectation of functioning in any professional/employment setting, IMO.

    Ditto for the "correcting the instructor in public" issue. I don't think one has to be "old-fashioned" to object to a student/subordinate correcting you publicly. Please explain to me who likes that. There are chains of command and appropriate ways to do that sort of thing. Anyone who doesn't understand that that should be addressed privately probably is going to have problems with lots of other aspects of nursing school, and, IMO, shows pretty poor basic judgment and social skills. Frankly, I'm not sure that penalizing a student for exhibiting these kind of behaviors (esp. if it continues over time, despite being counseled about them) is at all out of line or reflects poorly on the instructor or represents "wicked politics" -- indeed, it seems to me that is an example of the instructor doing her/his job.
    Last edit by elkpark on Mar 5, '13
    mharzi, AmyRN303, AOx1, and 9 others like this.
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    This is true not only of school but of the profession itself....sad really.
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    Quote from Esme12
    This is true not only of school but of the profession itself....sad really.
    And when you point out that people do a a bad or wrong job, they label it as bullying or picking on them.
    nguyency77 and Nascar nurse like this.
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    Quote from elkpark
    Are you suggesting that clinical in nursing school is the only situation one will encounter in one's career in which one will need to adjust to a superior's expectations and values?
    Nope, I'm not suggesting that nursing school clinical rotations will be the only experience in which people must to adapt to the values and demands of an authority figure or superior.

    However, many nursing students are culture-shocked by clinicals. I have seen bright students of all ages flunk out of clinical practicum because of personality clashes combined with the inability to back down from petty battles.

    In addition, some nursing students are at the age where they've never participated in the workforce, went straight to college after graduating from high school, and were treated like equals during their upbringing by their permissive parents. It can come as a jolt to some students when, for the first time in one's life, an authoritarian instructor lays down the law and has a 'my way or the highway' attitude. I'm not speaking for all students. I'm only speaking for a few.

    This is just a cautionary forewarning to adapt and mold oneself according to the expectations of the clinical instructor because his/her opinion is what matters at the end of the day (or semester).
    mharzi, Rebekah1882, pjgal2000, and 4 others like this.
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    Well done, as usual. Wish this had been written before I finished nursing school. A couple of friends could have benefitted from it.
    elprup likes this.
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    I had a friend who was a student in a respected nursing program who was outspoken enough in class, but otherwise scored invariably high As, that the professor was overheard calling the student's clinical scholar and unappologetically asking the scholar to find some way to fail the student on a subjective point in clinincal. The scholar thankfully refused to comply.

    I personaly was threatened with failing a clinical for an opinion I expressed in a weekly clinical log in the personal thoughts section (basically wishing for a heavier assignment to be challenged). I was basically told not to "complain" when asked for my thoughts. That person was just having a bad day, but there should be rubrics to prevent personal issues from imposing excessive influence in professional judgment.

    I think TheCommuter did a great job of idenfitying some pitfalls. I wonder if we might discuss some other ideas on how to change the system, a paradigm shift, to avoid some of these systemic progenitors of human drama. Ideas?
    Last edit by SummitRN on Mar 5, '13
    danlee, Heidi1978, mharzi, and 2 others like this.
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    Quote from elkpark
    Ditto for the "correcting the instructor in public" issue. I don't think one has to be "old-fashioned" to object to a student/subordinate correcting you publicly. Please explain to me who likes that. There are chains of command and appropriate ways to do that sort of thing. Anyone who doesn't understand that that should be addressed privately probably is going to have problems with lots of other aspects of nursing school, and, IMO, shows pretty poor basic judgment and social skills. Frankly, I'm not sure that penalizing a student for exhibiting these kind of behaviors (esp. if it continues over time, despite being counseled about them) is at all out of line or reflects poorly on the instructor or represents "wicked politics" -- indeed, it seems to me that is an example of the instructor doing her/his job.
    Why should anybody have to be silent when s/he knows that she's not learning the correct thing? There is a such thing as tactfully bringing it up and phrasing questions in less offensive ways, but I don't think any student should be penalized for gently pointing out that she's learned a different way to do something and asking questions. Instructors who haven't been in pt care in a few years should know that their techniques might be out of date, and they should be open to learning in the same way that we students are. That's a huge lesson opportunity for the professor, IMO. You're always learning in nursing. You never know everything, you're never perfect, and you can always improve.

    An instructor who would decide to hold a grudge against a student for appropriately questioning methods when there is a legitimate reason to do so doesn't seem like an instructor who is enough of a professional to be doing such subjective grading. I hope I never run into one in my nursing program.
    Lossea, jax67, arah, and 2 others like this.
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    Best lesson for nursing students. Be quiet. And smile. A lesson I learned again this week.
    I am a second degree student who in their previous career was always encouraged to have healthy conversations with my bosses. Not so in ns. Smile and take it. I may have a tattoo put on my body to remind my self.
    kalycat, mharzi, Rebekah1882, and 6 others like this.
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    My nursing school had clinical rubrics, so I respectfully disagree with the purely subjective part. Forgetting to wash your hands or not have the proper supplies resulted in an automatic "F" for the day, and this was made known prior to attending clinical. However, I'm sure sadly that this probably occurs in other schools.
    elkpark and soxgirl2008 like this.


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